The Democratic Republic of Congo (DR Congo) is experiencing an Ebola virus outbreak that has many in the public health community alarmed. The current outbreak was first confirmed on May 8, but until recently, the active transmission of the virus was confined to a few rural areas of the country. As of Thursday, May 17, that all changed as the World Health Organization (WHO) reported that one person had been infected with the disease in Mbandaka, a provincial capital city with a population of over 1.2 million people.

This important development greatly complicates the fight to slow down and halt the spread of the deadly disease – after all, fighting the virus in rural forest villages that often have single points of ingress and egress is much different than fighting it in an urban setting. To illuminate this point, Mbandaka is a port city on the Congo River that serves as an important transportation hub just downstream of Kinshasa, Congo’s capital with a population of about 12 million people. Therefore, if there is active transmission in Mbandaka, then the potential for the virus to spread even further is truly a disturbing reality.

Of course, if Ebola were to spread to other urban cities, the effects would be disastrous, to say the least. The current outbreak has had at least 45 reported cases, including three health workers, and 26 people are believed to have died due to the disease. These numbers pale in comparison to those reported during the 2014-16 Ebola epidemic, which caused more than 11,300 deaths. Nevertheless, with news of its spread into an urban city, it is certainly time to start asking the question: Is a public health emergency on the horizon?

Take Action Now and Hope for the Best

WHO experts and leadership say not quite yet. Last Friday, May 18, an emergency committee meeting was convened to discuss the international risks associated with this outbreak. It was determined that conditions for a Public Health Emergency of International Concern (PHEIC) had not been met… at least not yet. The good news is that the lack of a PHEIC designation does not prevent the flood of domestic and international resources from pouring into the affected regions. Quite the contrary – it seems like every lesson learned from the 2014-16 epidemic kicked into high gear this past week.

Border surveillance measures have been strengthened in 13 countries near Congo, where arrivals are screened for signs of the disease. At the various city ports of Mbandaka, infrared thermometers are being used to scan travelers, as well, even though the demand far outweighs the number of equipment on hand at this point. Elsewhere in the affected region, places where people congregate have started to provide hygiene basins, where people can use soap and water to wash their hands. Societal norms have also been pushed aside, as people are advised to not shake hands to greet one another. Furthermore, hospitals and clinics are making the transition to become Ebola receiving sites, or at the very least, began separating individuals suspected of being infected with the virus for isolation and treatment. In the field, responders are being equipped with personal protective equipment (PPE) and a large number of body bags are being supplied for burials.

The international community is also lending their support. The most publicized of which is the use of an unlicensed vaccine produced by Merck that produced very positive outcomes during the waning days of the 2014-16 epidemic. As of Monday, May 22, over 4,000 doses had been delivered to the country – the first to be vaccinated will be the responders, including health care and funeral services staff. Yet, this influx of medication does not come without its challenges – this vaccine must be stored in very low temperatures, and in a country that faces unreliable power supply, this is certainly an issue. In addition, a cadre of experts have been flown in and voluntary organizations are already in place opening treatment centers and conducting valuable surveillance work.

If we learned anything from the 2014-16 Ebola virus epidemic is that a sluggish initial response coupled with a lack of international attention does not help curb this deadly communicable disease. This time around, action is being taken early while hoping for the best.

Resources:

BBC: http://www.bbc.com/news/world-africa-44194065

The Globe and Mail: https://www.theglobeandmail.com/world/article-ebola-spreads-into-congolese-city-as-canadian-vaccine-arrives/

The New York Times: https://www.nytimes.com/2018/05/17/world/africa/ebola-congo.html

WHO – Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018: http://www.who.int/news-room/detail/18-05-2018-statement-on-the-1st-meeting-of-the-ihr-emergency-committee-regarding-the-ebola-outbreak-in-2018

WHO – WHO supports Ebola vaccination of high risk populations in the Democratic Republic of the Congo: http://www.who.int/news-room/detail/21-05-2018-who-supports-ebola-vaccination-of-high-risk-populations-in-the-democratic-republic-of-the-congo